What You Should Know About:
As we age, sun damage, genetics, gravity, diseases (e.g. acne) and even daily expression can cause lines, wrinkles, hollowing, and depressed scars. These changes alter the way we look and present ourselves to the world. Our faces are essentially an organ of communication. We may be feeling one set of emotions, yet our faces may communicate another. While some lines can be erased by lasers, and sagging can be reduced by face and neck lifts, one of the most common and easy methods to diminish lines is through the use of filler and Botox.
There is a vast array of fillers. Some are better for enhancing lips, others are better for cheek hollowing. Some last just a few months; others may last for more than a year. Some are permanent. Most do not require allergy testing.
My philosophy is to match the filler to the needs and concerns of the patient. This may require multiple sessions and multiple fillers. Generally, I do not advocate permanent fillers because as the face ages, a permanent filler may not adjust to the new lines and repositioning of old ones.
Following is a list of common fillers and what they are best used for:
This is DNA produced collagen. No allergy testing is required. Cosmoderm is best used for fine lines and small acne scars, as well as the lips. Cosmoplast is best used for nasolabial folds (smile lines), the lips, and larger depressed scars. Cosmoderm may be layered on top of another filler. Usually, these products don't need injections of local numbing medication. Though both products provide excellent results, its longevity may be only 3 months.
Optimal Use : If patient wants an effect for a very temporary amount of time i.e. if there is an important event in the near future.
This product is a made of hyaluronic acid which is a building block in the skin. It does not require allergy testing. Similar to collagen, it can be used to augment lips fill small scars, and diminish smile lines as well as marionette lines. Its main drawback is its longevity which is about 4 months.
Optimal Use : For the individual who desires short term lip enhancement.
This product is also a form of hyaluronic acid, but has a higher concentration, and is thus more viscous. It is very versatile and can be used for lip enhancement, reduction of smile and marionette lines, scars, as well as under the eyes and vertical creases in the glabella (lower forehead). It may require an injection of local anesthetic. Restylene generally lasts six months, but may be less in mobile areas of the face such as the lips.
Optimal Use : Lip enhancement and reduction of smile and marionette lines.
This product is made out of calcium hydroxylapatite in a gel form. It is biocompatible and inert. It has been used to stabilize vocal cords and also in the bladder and as a radiographic marker. While it is used for cosmetic purposes, this is considered off-label usage since it is not approved by the FDA specifically for this purpose. It has been used in this off label purpose in the face for several years. It is an excellent filler for the smile lines, marionette lines and hollowing of the cheeks. It can also be used for glabellar furrows and some acnes scars. Because it is fairly viscous, less of this product is need to fill lines compared to collagen or hyaluronic acid. Numbing injections are needed for this filler. It lasts for approximately one year.
Optimal Use: For deep smile lines.
This product is made out of a biocompatible material known as polylactic acid. It has recently been FDA approved for HIV associated lipoatrophy. It requires multiple treatments, but has been shown to last up to 18 months. Some practitioners are beginning to use it in an off-label manner for aesthetic uses.
Optimal Use : For cheek hollowing secondary to HIV.
This is the oldest and most natural of all the fillers. Using tumescent (local anesthesia) Fat is removed from the patient's abdomen or hip via a liposuction cannula. The fat is then concentrated, and injected into the face. It requires three treatments 2 months apart. In my hands, after these three treatments, fat will provide approximately a 70% correction for approximately 3 years.
Optimal Use : Smile lines; hollowing of the cheeks
Adverse Effects: With all of these products, there is a risk of adverse effects, though fortunately they are uncommon. There can be infection and bruising/bleeding. There may be asymmetry. There may also be a risk of small bumps along the injection site known as granulomas.
There will be more products on the market in the near future. There is a thicker, longer lasting hyaluronic acid being tested. Microdroplet silicone is being used for HIV lipatrophy, and appears very promising. In Europe and Asia , there are permanent fillers made of polyacrylamide gel which has provide good results with minimal side effects. We will keep you posted.